Name of the Bank... Branch... LOAN APPLICATION FORM FOR AGRICULTURAL CREDIT. (Production Credit/Crop Loans/KCC/Agri-Term Loan)
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1 Name of the Bank... Branch... To: The Branch Manager... LOAN APPLICATION FORM FOR AGRICULTURAL CREDIT (Production Credit/Crop Loans/KCC/Agri-Term Loan) A. For Office Use: Application Sl. No. Category SF MF Others B. Purpose and Type of Loan facility (Crop Loans/KCC/Agri-Term Loan) - Applicable Interview cum appraisal form to be enclosed to this application, depending upon the purpose of loan. Purpose of Loan Type of Loan facility / Scheme Amount required (`) C. Particulars of the applicant(s) Full Name(s) of the Applicant(s) Date of Birth Age Gender Aadhar No. (Optional) Voter s ID/ DL/PAN No. D. Details of family members: Sl. Name of the family No. members 1. Age Gender Relationship Occupation Annual income (`)
2 Name of the Karta (in case of Joint Hindu Family) E. Address with Contact Nos. Present Address House No: Street No: Village: Post Office: Taluk/Mandal: District: Pin: Telephone/Mobile No.: Permanent Address House No: Village: Post Office: Taluk/Mandal: District: Pin: Street No: F. Social Category: Social Category SC ST OBC Physically If Minority Community Minorities Handicapped Buddhists Muslims Christians Sikhs Jains Zoroastrians G. Existing Banking/Credit Facilities: Type of Facilities Presently Banking Account No. with Savings Account Fixed Deposit PMJDY OD Account CC/Term Loan Whether Covered Under PMJJBY/PMSBY/APY If banking with this bank, customer ID to be given here: Balance Outstanding (`) H. Particulars of total land holdings of the applicant (If Lease hold/share cropper, specify): Name of Survey/ Title Area in Of which Encumbrance the Khasara acres irrigated if any village No. Owned Leased Share Cropper I. Of total landed properties mentioned at (H) above, land / crop details pertaining to the loan applied: Name of the Survey/ Area in Source of Name of Crops to be grown
3 Village Khasara No. acres Irrigation Khariff Crops Rabi Crops Other Crops J. Source of Income: Agricultural Income Other Income (Specify) Total Income K. Particulars of Immovable Assets Owned: Immovable Assets Particulars / Description Present Market Value (`) Agricultural Land Non Agricultural Land House / Building Tractor Shed / Farm Shed Fishing Ponds / Tank Total Value: L. Particulars of Movable Assets Owned: Movable Assets Particulars / Description Present Market Value (`) Plough cattle/miltch cattle Poultry birds Tractors Power tiller Elec. Motor / Pumpsets Other implements Total Value: M. Particulars of existing liabilities as borrower, if any: Name of the Institution Purpose of Loan Balance Our Bank Other Banks Agricultural Credit Societies Land Development Bank Other Creditors (Gov. Dues) Total Outstanding: Outstanding (`) Of which overdue Security offered N. Net Worth of Applicant(s): {(K+L)-M} `... O. Particulars of Liabilities as Guarantor:
4 Loan sanctioned to. Name of the Bank/ Institution Amount of Loan (`) Balance Outstanding (`) Status of Account: (Regular/Overdue) P. Security Proposed to be offered: Particulars of Primary Security offered Particulars of Collateral Security (where applicable) Q. Guarantors offered (if any): Names of the Guarantors Age Residential Address Telephone No/ Mobile No Occupation Net Worth (`) R. Declaration: I/We hereby declare that all information furnished by me/us is true, correct and complete to the best of my/our knowledge and belief. I/We have no borrowing/liabilities excepting those mentioned in the application form. I/We hereby authorise the Bank to disclose all or any particulars or details or information relating to my/our loan accounts with the Bank, to any other financial institution, government or any agency(ies) as may be considered necessary or desirable by the Bank. It will be in order for the Bank to disqualify me/us from receiving any credit facilities from the Bank in case it is proved that the declaration of my/our outside borrowings made above contain misrepresentation of facts. I/We hereby undertake to abide by the terms and conditions that the Bank may stipulate in sanction of this loan and inform Bank in the event of acquiring any other assets during the tenure of the advance. The Bank may take appropriate safeguards/action for recovery of bank s dues
5 3. 3. Signature/thumb impression of Borrowers Signature/thumb impression of Guarantors Date:... Place:... CHECK LIST: (The check list is only indicative and not exhaustive and depending upon the requirements of the bank addition/deletion could be made as per necessity) 1. Proof of identity: Self attested copy of Voter s ID Card / Driving License / PAN Card / Aadhar Card / Passport / Photo Ids issued by Govt. Authority, etc. 2. Proof of Residence: Recent telephone bill / electricity bill / property tax receipt (not older than 2 months) / Voter s ID Card / Aadhar Card / Passport / Certificate issued by Govt. Authority / Local Panchayat / Municipality etc. 3. Applicant s recent Photograph (2 copies) not older than 6 months. 4. Particulars of Land Records.
6 ACKNOWLEDGEMENT Received the loan application from... Residence of... On... for the purpose of... All the required information / documents have been furnished on.../ yet to be furnished by the applicant. Date:... Officer / Manager...Cut Here... Customer copy: Received the loan application from... Residence of... On... for the purpose of... All the required information / documents are furnished on... / yet to be furnished by the applicant. Date:... Officer / Manager Please Note that: 1. This is only an acknowledgement for having received the application and this should not be constructed as an indication of our acceptance of the proposal, a decision on which will be taken only after due consideration of the proposal on its merit and / or on fulfilment of conditions if any, that may be stipulated by the Bank. 2. The application will be taken up for consideration only after all the particulars / data / documents as may be required are received by the Bank. 3. The application will be disposed off within... days from the date of receipt of all the details / papers / documents / clarifications sought by the Bank. 4. In case the proposal is rejected / not considered the reasons for the same will be intimated to the applicant.
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